Individual
CHARLES ROGER LYONS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 MANCHESTER AVE, WABASH, IN 46992-1425
(260) 563-7421
(260) 563-7725
Mailing address
1025 MANCHESTER AVE, WABASH, IN 46992-1425
(260) 563-7421
(260) 563-7725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01022249
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082846
BCBS
—
05
—
100084290A
—
IN
01
—
10336
PHP
—
Enumeration date
07/29/2005
Last updated
05/13/2008
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